Medical School in the UK, Residency in the US

Today’s Medical Education Monday post is one I have been looking forward to reading since he offered to write it for me a few weeks ago! Nick Bennett (@peds_id_doc) is a Pediatric Infectious Disease Fellow in Syracuse, NY and he has a very unique perspective to share with the Mind On Medicine readers today. Dr. Bennett went to medical school (and got his PhD…overachiever…does that mean we call him Doctor Dr. Bennett? I think it does.) in Cambridge, UK, but chose to do his residency in the United States. Medical school in one country, residency in another – what a unique and valuable addition to to this series!! In addition to being a bug-killer extraordinaire, he is interested in teaching communication skills, antibiotic stewardship and software-driven data analysis (from what I’ve gathered on Twitter he’s the owner of some geeky computer skills – something I’ve come to regard highly after marrying a software developer – that stuff is no joke). I hope his information can help someone looking to do something similar, but I can assure you that his story is a great read even if you never plan to practice medicine somewhere other than your country of training…actually even if you never plan to practice medicine at all.

I’m in the interesting position of someone who went to medical school in one country (UK) but completed residency in another (USA). My reasons for doing so are, on the surface, fairly simple (my wife is an American) but it goes a bit deeper than that. One issue that was important was the fact that in the UK the junior doctor jobs often involve moving from hospital to hospital, spending only a few months in the same place. The alternative was to move once and stay at the same hospital for several years. It seemed like a simple decision!

The problem I immediately ran into was – just how the heck do I do this? There was absolutely no careers advice for those of us who wanted to leave the NHS (National Health Service). I’d even been to careers advice forums where the speaker opened with, “This is really for all the scientists here, as doctors have it pretty much sorted out.” Yeah, thanks.

Searching online revealed two basic hurdles – exams and visas. The US assumes that every other medical school in the world has exams that aren’t reliable. You not only have to graduate from your medical school (if it is on the list of acceptable schools!) you have to pass US medical school exams as well – the USMLE Step 1 (the test I take Friday) and 2. For most people this is an annoying formality, but there are two issues here: Step 1 is basic science – you may be many years from your pre-clinical training and hence quite rusty (as I was) by the time you take it – and Step 2 has a heavy US bias, so you have to re-learn minor facts of epidemiology as well as have a basic knowledge of US geography and the medical conditions, typically infections, that are more common in certain states.

The exams are required for certification by the ECFMG – the Educational Commission for Foreign Medical Graduates. Along with your medical school records, passing the Step exams is needed to obtain ECFMG certification, which is required to start a training program in the US as a Foreign Medical Graduate (FMG). It is quite expensive in terms of fees and exam costs, but if you want the training you have to invest the money.

The second issue of a Visa was one I was thankfully helped with by marrying an American! The more typical approach is to obtain a H1B or J1 training visa. These are sponsored by the residency program or the ECFMG, so you have to have been accepted by the program before that can move forward. Not every program will sponsor training visas so focus your efforts on those that do. FMGs are often at a competitive disadvantage compared to US graduates, but some programs are very supportive so it can pay to do your homework about a particular place to find out how they stand on that issue. If you have contacts in a residency program in the US that’s probably the best way to get the inside scoop.

I was very lucky in getting the program I wanted – I was taken “outside of the match” which means I didn’t have to deal with the NRMP(National Resident Match Program), which I gather can be quite stressful and complex, especially for non-US graduates. As such, I’m rather odd in that I can’t offer any advice on visas or matching! I did it through networking and spending time here as a student doing an elective. That kind of exposure is priceless when it comes to applying for a residency position (spending time doing away rotations in places you want to do residency is sound advice for ALL medical students, not just for those looking to go to a new country to finish their training).

There are a few websites out there with advice on moving to the US. They’re worth reading to be prepared for some of the inevitable culture shock. Oddly enough, the effect was perhaps weirder coming from the UK. Enough of the lifestyle and society was similar to the UK that when something WAS different it seemed more of a surprise. Silly things like having to add sales tax onto prices and paying for checking (current) accounts were hard to get used to, you get used to it, though.

Once I was here a few things became quickly apparent. The first was that although it seemed as if my medical school training gave me an excellent basic medical science background, but I felt wholly unprepared for actual patient care. The US students were given more responsibility and seemed more involved in patient care that I had been. The other FMGs that were starting with me tended to have already completed a residency in their own country. I was lucky in having a graded experience working up from the newborn nursery to the ER and excellent senior residents, but I know that had I started out in the ER things might not have gone so well! My learning curve was near vertical, but I kept my head above water enough to keep going. Once I was settled in it was also clear that despite all I had heard about the “evil US profit-driven healthcare system”, the actual practice of medicine was basically the same as it was in the UK. Docs still made decisions based on best practice and in the patient’s best interests, at least in the academic setting. Only rarely did insurance ever come into play – usually when patients didn’t have any and we had to cut corners to save them some money.

Later, as a Fellow, I ran into the issue far more frequently, when having to obtain “prior authorization” for treatments that insurance companies would rather not pay for. I’ve also heard and seen more discouraging practices from the non-academic world, which although not unique to the US are far less likely in the system I came from. Everything from pharmacy costs to malpractice premiums is shifted upwards, and it’s easy to see how the US ends up spending twice as much as any other developed country for no additional benefit.

There were several advantages to coming here that I really didn’t anticipate. Back in the UK I recall asking my research supervisor how I could get to be someone like him. He replied that I should focus on medicine for the first 10 years or so before trying to come back to research. When I asked the same of my mentor here in the US he said “Well, you’ll have to wait until at least the second year of Residency…!” As it happens, in my Intern year I started writing online medical review topics, helped out with clinical trials and started a new medical education initiative for the students. It seems as if people are very willing here to support junior doctors in the kinds of extra-curricular activities that would otherwise have to be put off for years in the UK. That’s not to say that every FMG becomes a world-famous clinical educator or researcher, but that it just seemed to me that the opportunities were better for me here. In addition, it’s very clear that people do all kinds of things with their medical training here. In the UK I felt as if I was being channeled into the NHS and it seemed there was no way to easily merge education or research into my daily activities. In the US it is equally valid to choose private practice as it is to choose academics, industry, or government work – in fact, many mix and match.

I think I got a great education from the UK, and I didn’t leave specifically because I couldn’t get what I wanted there – it was for personal reasons, but it turns out that making this move to the US was a really great professional decision, too.

Thanks Danielle for tracking him down and Dr. Bennett for providing awesome insight into some of the differences between US and UK medicine.

Important details like when a doc can pursue opportunities in research are often overlooked, but important to individuals like me who like options in life! I think it creates new appreciation for the flexibility that US education offers in terms of professional development and professional opportunities. (At least, that is what my parents have always told me since they grew up and were educated abroad.)

StephAugust 2, 2011 at 6:21 pm

What an interesting story and brilliant achievement! I’m just wondering, did you not complete F1/F2 in the UK first, or did you go straight from graduating to the US for residency? Thanks

Hi Steph – I went straight from med school. I didn’t bother doing the PRHO year (at the time there wasn’t even a second foundation year!).

Everyone, with one exception, told me to do that. As such, I do not have registration/licensure in the UK. The advantage was that I didn’t “waste” time on training that wasn’t going to count for anything once I got here. The disadvantage was that I felt I lacked clinical exposure, even compared to the US graduates. Most of the foreign graduates had done a residency abroad before coming to the US for additional training.

It was a VERY steep learning curve on the wards, compounded by having to re-learn some of the drug names and laboratory reference ranges/units.

If I had my time again, I’d do exactly the same thing, but I’d read up a bit more on what was needed to transition before making the leap! Although a year or two in the UK on the wards would have given me a huge amount of clinical experience, those would be two additional years of training that I frankly wouldn’t have needed to get where I am today. Obviously

Part of my rationale was that – as a PRHO you move hospitals every 4-6 months. As a US resident you stay put in one place. I could move once (to the US) then settle down. I’ve been at the same hospital for 7 years, with one away elective I chose to do.

KimberleyJanuary 6, 2012 at 2:59 pm

Thank you so much for all of the information you have shared here. I am a 16 year old high school student in the uk and this year I will hopefully be applying to go to med school here. I have wanted to live in the states for as long as I can remember and I have also wanted to be a doctor since I was little. My dilemma is trying to Persue both of these ambitions. I know that it’s a long long way away yet but I want to find out as much as I can as ideally I really want to do my residency in the US, I’m prepared to work super hard for this. However I have spent forever searching the Internet for guidance on this subject and this is the only thing I have found useful, so thank you so much, it’s good to know that this can actually be achieved! If you know of any other websites or books that I can read up on transferring to the united states after studying here in the UK I would be extremely grateful for your help, I really don’t know where to start looking, thanks.

Danielle JonesJanuary 29, 2012 at 1:59 pm

Hi Kimberley,

I’m really glad you found the post helpful. I don’t know of many other resources, but I do know that Nick is a wonderful doctor and is always open to questions from those interested in his career path. You can contact him through Twitter (@peds_id_doc) or send me your email (MindOnMed@gmail.com) and I’ll get it to him and see if he minds contacting you.

I’d be happy to help out as much as I can with advice and ideas. It really would be useful to do medical school in the UK and then try for residency positions here, bearing in mind that you’ll have to have an idea of the speciality you want to go into early on… It is difficult as a foreign med grad, but easier if you get a student placement/elective at the institution(s) you are applying to. At the very least, a US reference letter will count for a lot.

Drop me a line – njb35 @ cantab.net

Remove the spaces 😉

Bennett

CheezzFebruary 4, 2012 at 5:38 pm

I just wanna commend your blog, i ve found the articles useful and informative, especially the above article. I’m a nigerian medical student in 2nd year and i plan to do my residency in the uk or us. I ve been searching the net for info on similarites and differences in medical education in my country and us/uk. I found this blog informative. Thanks

Tom LeverMay 6, 2012 at 7:18 am

Hi Bennett,

Thanks for the invaluable information. I am 3yr Med Student in UK and there isn’t much information out there so really appreciate it. Can I please ask what effect this has had financially? Like the cost of all the exams and conversion to the US? I am concerned about the initial cost of it all…

Can I ask what were the main reasons you decided to complete your residency in the USA? And what factors affected the locality that you applied to?

Thanks again,

Tom

Danielle JonesMay 10, 2012 at 12:46 pm

I’ll let him know you have questions, Tom! Is there an email he can contact you at? Feel free to email me: (MindOnMed@ gmail.com) if you want to give me an email address he can contact you at.

Saklain FarooqMay 31, 2012 at 11:14 am

Hi

This is a great article, thank you very much. I’m a 1st year Med Student in the UK, and was wondering what I would have to do to get into an orthopaedic surgery residency in US?

I know it’s extremely competitive, but just want to know the actual practical steps to getting exactly what and where you want.

Hey Saklain, thanks for stopping by! Nick wrote this article for me and I agree – he did a great job. It’s one of the most popular Med Ed Monday articles I’ve had! If you’d like to get in touch with him you can do so via Twitter (@peds_id_doc) – I’m sorry I can’t answer your questions, all the info I know about this comes from his article right here lol. Best of luck!

Saklain FarooqJune 3, 2012 at 4:55 pm

Oh sorry about that :/
Thanks anyway

DownUnderJuly 30, 2012 at 8:36 am

I’m an Aussie med student looking to go to the States! Maybe I’ll have to let you know how I go as well. Cheers from sunny (although currently rainy) Sydney!

Danielle JonesAugust 2, 2012 at 6:23 pm

We’d be happy to hear your story, let us know if you want to write eventually!

MkrNovember 8, 2012 at 8:59 am

Hey!
this is really helpful, thanks.
How competitive is it to get into a residency programme in the US? Im a US citizen but am currently enrolled in a graduate entry medicine programme. I definitely want to do F1/F2 here in case I want to come back. What do you think are the differences/advantages of the US residency programme compared to lets say surgical training after F2 training in the UK?
thanks a lot x

BTKDecember 6, 2012 at 10:54 pm

Im a 5th yr med student in the UK and have always had ambitions of practising in the US. One question for the doc – how important is having research under your belt when applying for US residency positions? (General Surgery to be precise)

RogerSeptember 14, 2013 at 8:24 am

Hi, I was wondering how it was possible to get a residency program without going through the NRMP? Sounds amazing! Thanks

DaniDecember 26, 2013 at 8:47 am

Hello Denielle and Dr. Bennett,

Although I´m not a medical student or a doctor, I´m doing some research on medical students in Europe, their questions, worries and aspirations, and have found that they have a lot of inquiries and as we can see from the earlier posts –not a lot of answers.

I live in Spain and have quite a few friends from the UK we are always talking about the differences and similarities between the UK and US, so I have gained some very interesting insight from Dr. Bennett. I´m really glad that I took the time to read it!

My interest in this topic was kindled when I was offered a job to go to Italy to teach an intensive course in general English for Italian prep students, who were preparing to start the university to study medicine. At the university where we were doing the course, I was able to interact with my students and with some of the teachers who came from other Europian countries to teach other topics, such as Chemistry, Biology and Physics in English. I had tapped into the world of studying medicine, the high competition and met really great young men and women who aspire to become doctors.

During our chats at lunch hour I had learned that they had so many questions and worries –and were asking me!! I wanted to help them and answer their questions but I was only there to cover the material that I had to teach them. So, I deided to contact my brother who has been a doctor for many years in Chicago (where I am originally from) and asked him all the questions the medical students were asking me, and he was delighted to help out. I also asked him if he could offer some professional advice to them and he did.

Later, in one of the classes when we had a break, I stayed in the classroom and told them that I had spoken to my brother who was a doctor and they decided to use the break to listen. They were very grateful and happy to get advice from a doctor who was from the US. They asked me a lot more questions and I took note and got back to them in other classes. I may not be a doctor because I am a word person and a more artistic type of person, I enjoy writing, investigating different topics, learning new things, painting and so on, but I´m a teacher and a very communicative person, so I was very happy to teach the prep students general English for medicine but I was also very happy to go a bit further to try and help them out with their questions which were off the topic of our class subject.

At the end of the course, they were very happy and so was I that we all enjoyed our time in the classroom and some of us kept in touch! They say hi once in a while, so I am definitely going to recommend your site and read what Dr. Bennett has written here! I am really glad to know that this communication is going on and helping a lot of medical students out there from all over the globe!

Kind regards, Dani

chev nalingAugust 19, 2014 at 3:43 am

Hi,

Thank you for this insightful piece that you have written, it was hugely informative and very interesting to read.
I am a medical student in America, however I am British myself and only moved to the US a few years ago to begin my studies.
I would like to return to England in the future and settle down as my partner is living there and have been trying to gain information with regards to residencies in America and how they translate in England.
For some reason I am struggling to find anything, perhaps it’s not very common for a medical student to study in the US and return to England.

I was wondering if you have any information on this or perhaps can refer me to someone that may. I am mainly interested in finding out if I take up and complete my residency in the US would I have to start from the beginning again in England(do the F1 and F2 years)?

No banker has the right to question any one about responsibility.
He’s bouncing around on floor, did a casual triple full, and
is the only guy so far to do something real on vault — a couple handspring double fronts,
to be exact. We need health care, but you best believe that bunch of moral midgets in Congress won’t be standing up to Pharma
and the Insurance companies let alone the AMA very soon.

AnonymousJune 15, 2015 at 2:26 am

Quite intriguing, what it is like studying medicine in the UK as compared to the US. I am a graduate of Medicine in a newly established university in Nigeria, but then I have tried out figuring if it is well recognized. I am confident about the training and will like to go for my residency next year. I am still having a big contemplation where it should be. Well I know how recognized the medical school is plays a big role in the US, and then the USMLE exams is another. Not so clear about cost implications though as compared with the UK. If I could get a break down on that I’d appreciate.Then I want to know if a license of practice and a full year of certified internship ( Horsemanship ) is a good enough first step or if not, what other requirements should I consider? Thanks.

JenniferAugust 28, 2015 at 11:34 am

Hi there,

I am currently in the same situation. I was born in Scotland but have lived in America most of my life but I am currently in my 4th year out of 5 at the University of Glasgow and am looking into moving to the US when I graduate. I’ve been reading all about ECFMG certification at the match but I’m having trouble figuring out the best timeline and it seems like I will need to wait until the after I graduate to apply for the match for residency programs. But that means there will be basically a year time gap and I’m not sure what my options are. I was planning on doing my F1 in Scotland and at least getting GMC certification but their program runs from August to August and if I was matched in the USA the residency program starts in July. Do you guys have any suggestions on what my potential options are or where to find out more information? I really appreciate your help and advice.

Kind Regards,

Jennifer

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I'm an ObGyn. I started this blog as a medical student (some would call that doctor school) and now I'm working as an Ob/Gyn, which is seriously the coolest job ever. I'm a twin mom and recently added a baby brudder to the mix. My life story through November 2010 can be viewed here. The events in the many years following can be summed up as wedding bells, books, exams, babies, and doctoring. I started this blog in hopes of landing a role in a Lifetime movie so I could quit medicine and move to Hollywood, but that hasn't happened...so if you wouldn't take medical advice from Angelina Jolie, you shouldn't take it from me. I may not even be a real person. In fact, I'm probably a spambot. Or possibly a 15 yo boy blogging from a dingy basement. If you're really interested you can read more about me here. If you have any questions or want to guest post contact me.

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